Provider Demographics
NPI:1225071244
Name:OLSON, JAMES JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 PAYNE ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2509
Mailing Address - Country:US
Mailing Address - Phone:847-677-7250
Mailing Address - Fax:847-677-7251
Practice Address - Street 1:9631 GROSS POINT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1264
Practice Address - Country:US
Practice Address - Phone:847-677-7250
Practice Address - Fax:847-677-7251
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036080165208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F75962Medicare UPIN